Language milestones

Also called Ages and stages, Developmental milestones, Speech and language milestones

The ages and stages, given the way the NHS gives them: as a range, with the signs that matter more than the dates.

What it is

Milestones are the skills most children have by a given age: a first word around one, two-word phrases around two, sentences by three, mostly clear speech by four. They're averages drawn from large groups, and every one of them has a wide normal range around it.

They're useful for one thing: spotting the child who needs a closer look. They're harmful for another: making a parent of a fourteen-month-old with no words feel that something is wrong, when for most such children nothing is. Read them as ranges, and read the whole picture, not the date.

Who it can help

Parents, health visitors, nursery staff and teachers. The routine points where they're checked in England are the health visitor reviews in the first weeks, around one year, and at two to two and a half, plus the school entry checks. Between those, it's parents who notice, and they're usually right.

Milestones are least useful for children with a known condition that changes the path: a child with Down's syndrome, cerebral palsy or hearing loss is on their own trajectory, and comparing it to the typical one tells you little you didn't know. For those children the question is "are they progressing?" not "are they on time?"

How it works

The broad shape, in ranges. First year: responds to sounds and voices, babbles with real syllables by around ten months, follows a point and points back by around a year. One to two: first words around the first birthday, understanding of simple instructions, around fifty words and the start of two-word phrases by around two. Two to three: vocabulary growing fast, three and four word sentences, understanding two-part instructions, speech understood by familiar adults. Three to four: longer sentences, questions, telling simple sequences, speech mostly understood by strangers. Four to five: conversation, stories with a beginning and end, most speech sounds in place with a few still developing (speech sound ages). Language keeps developing through primary and secondary school: complex grammar, abstract words, inference, and the language of reasoning.

Signs that matter more than any date: no response to sound, no babbling by around a year, no pointing or gesture by eighteen months, no words by two, no combining by three, loss of words or skills at any age, a child who's frustrated at not being understood, or a parent who's worried. Any of those is a reason to ask now.

Getting started

Look at the whole picture. Understanding, gesture, play, interest in people, and speech. A child with few words who points, understands and plays with you is in a very different place from a child with few words who doesn't.

Write down what you see, with dates: words, phrases, what they understand. It makes the conversation with a health visitor specific, and specific gets a faster answer than "I'm a bit worried".

Don't wait to be told. If the review isn't due for months and you're worried, contact the health visitor anyway, and check whether your area's speech and language therapy service takes parent referrals; most do.

Where to get help

The NHS guides by age, from 0 to 6 months to 3 to 5 years. Speech and Language UK gives ages and stages up to seventeen and runs a free helpline. Afasic supports families when the milestones aren't being reached.